Key facts for NCD 230.19
- Benefit category
- Drugs and Biologicals
- Effective date
- 06/19/2006
- Implemented 06/19/2006
- Transmittal
- Transmittal 48
- Versions published
- 2
- Manual chapter
- 230
- NCD Manual (Pub. 100-03)
TL;DR
NCD 230.19 sets Medicare's national policy for levocarnitine for use in the treatment of carnitine deficiency in esrd patients under the benefit category "Drugs and Biologicals", effective 06/19/2006 and implemented 06/19/2006. Intravenous levocarnitine, for one of the following indications, will only be covered for those ESRD patients who have been on dialysis for a minimum of three months. It has been revised 1 time since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
CIM 45-32
Carnitine is a naturally occurring substance that functions in the transport of long-chain fatty acids for energy production by the body. Deficiency can occur due to a congenital defect in synthesis or utilization, or from dialysis. The causes of carnitine deficiency in hemodialysis patients include dialytic loss, reduced renal synthesis and reduced dietary intake.
Indications and limitations of coverage
Intravenous levocarnitine, for one of the following indications, will only be covered for those ESRD patients who have been on dialysis for a minimum of three months.
Patients must have documented carnitine deficiency, defined as a plasma free carnitine level
• Erythropoietin-resistant anemia (persistent hematocrit
Continued use of levocarnitine will not be covered if improvement has not been demonstrated within 6 months of initiation of treatment. All other indications for levocarnitine are non-covered in the ESRD population.
For a patient currently receiving intravenous levocarnitine, Medicare will cover continued treatment if:
• Levocarnitine has been administered to treat erythropoietin-resistent anemia (persistent hematocrit
Text reproduced from the CMS Medicare Coverage Database record for NCD 230.19 version 2. View the original on cms.gov.
Revision history
03/2006 - Correct typegraphical errors from conversion of CIM to NCD. Effective and implementation dates 06/19/2006. ( TN 48 ) (CR4278)
11/2002 - Implemented National Coverage Determination for Levocarnitine for End Stage Renal Disease under §1862(a)(1)(A) of the Social Security Act. Effective and implementation dates 01/01/2003. ( TN 162 ) (CR 2438)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 230.19
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 230.19
What does NCD 230.19 cover?
Intravenous levocarnitine, for one of the following indications, will only be covered for those ESRD patients who have been on dialysis for a minimum of three months. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 230.19 take effect?
The current version (2) is effective 06/19/2006, implemented 06/19/2006, published in transmittal 48. CMS lists 2 versions of this NCD.
Does a Local Coverage Determination override NCD 230.19?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.